Dyspnea

Question 1

Define Dyspnea

Answer 1

Breathing discomfort of varying intensity

Question 2

Define Chronic dyspnea

Answer 2

• Dyspnea ongoing for >1 month

- Acute is more life threatening

Question 3

Shortness of Breath

Answer 3

• SOB
• Description of dyspnea
• Different than dyspnea on exertion (DOE)

Question 4

Define orthopnea

Answer 4

• Dyspnea while lying supine

- Occurs in CHF due to pulmonary edema

Question 5

Define paroxysmal nocturnal dyspnea (PND)

Answer 5

• Waking up suddenly at night due to SOB
• Specific finding in CHF
• Also occurs in obstructive sleep apnea, GERD, Asthma, & PTSD

Question 6

Define Platypnea

Answer 6

-Dyspnea worsening in the upright position

Question 7

Define orthodeoxia

Answer 7

• Drop in arterial pO2 in upright position

- Occurs in arteriovenous malformations (liver disease)

Question 8

BNP

Answer 8

• Brain natriuretic peptide
• Neurohormone from myocytes of ventricles
• Produced in response to fluid overload
• Suggestive of CHF
• If <100pg/mL makes CHF VERY unlikely

Question 9

Define Vocal cord dysfunction

Answer 9

• Vocal cords contract on inspiration (opposite of normal)
• Occurs with stress or irritation
• Causes SOB and wheezing
• Often confused with asthma
• Diagnosed with flow volume loop and laryngeal scope
• Treat with speech therapy

Question 10

Causes of Tachypnea

Answer 10

• CHF

- Pulmonary vascular disease

Question 11

Symptoms of Asthma

Answer 11

• Incomplete exhalation
• Heavy breathing
• Tight chest

Question 12

Causes of shallow breathing

Answer 12

• asthma
• neuromuscular disease
• chest wall disease

Question 13

What diseases cause increased work or effort in breathing

Answer 13

• COPD
• Interstitial lung disease
• Asthma
• neuromuscular disease

Question 14

Causes of feeling like suffocating

Answer 14

• COPD

- CHF

Question 15

Causes of Air Hunger

Answer 15

• COPD
• CHF
• Pregnancy

Question 16

Timing of dyspnea

Answer 16

• Intermittent:
  
  • Asthma
  • Recurrent PE
  • Cardiac Ischemia
• Chronic:
  
  • COPD
  • Fibrosis

Question 17

Presentation of Congestive Heart Failure

Answer 17

• DOE, PND, orthopnea, edema
• HTN, JVD, murmur, gallop, HJR, crackles, wheezing
• CXR: cardiomegaly, interstitial edema, kerley B lines
• BNF <100 rules OUT CHF
• Troponins: increased indicates infarction/ischemia
• ECG:
  
  • infarction: ST elevation, Q waves, LBBB
  • Ischemia: ST depression, T wave changes
  • Arrhythmia
  • Low QRS voltage: pericardial effusion
  • HIgh QRS voltage: hypertrophied ventricle

Question 18

Presentation of Acute Coronary Syndrome

Answer 18

• Risks: male >45; female>55; diabetes, obesity, family history, smoking, high LDL, low HDL
• History: radiating chest pain, diaphoresis, SOB
• Physical: tachycardia, signs of HF, painful palpitations
• Same tests as CHF

Question 19

Clinical Presentation of Pneumonia

Answer 19

• Risks: elderly and immunocompromised
• History: cough, purulent sputum, pleuritic chest pain, chills, myalgia
• Physical: Fever, rhonchi, increased fremitus
• CXR: consolidation or air space in area of infection
• Tests:
  
  • Blood: Increased WBC w/ band forms (LT shift)
  • Blood and sputum cultures

Question 20

Clinical Presentation of Pulmonary Embolism

Answer 20

-Risks: Immobilization, surgery, DVT, prior PE, cancer, travel, pregnancy, oral contraceptives
-History: sudden onset SOB, syncope, pleuritic chest pain, hemoptysis
Physical: fever, tachypnea, tachycardia, hypoxia, hypotension, RT heart failure
-Signs of DVT: Homan’s sign (leg pain w. foot dorsiflexion)
-CXR: May be normal
-Atelectasis, effusion, infiltrate
-Westermark’s sign: loss of vasculature markings due to low blood flow beyond clot
-Hampton’s hum: wedge/triangle opacity from infarction
-Additional test: CT angiogram, D dimer, ECG

Question 21

Clinical presentation of COPD

Answer 21

• History: purulent sputum, smoking, dyspnea
• Symptoms improve w. bronchodilator, worse w/ B-blockers
• Physical: barrel chested, finger clubbing
• CXR: air trapping including flattened diaphragms
• Pulmonary function test: FEV1/FVC < 70%

Question 22

Clinical presentation of asthma

Answer 22

• Also obstructive lung disease
• History: dyspnea, wheezing, chest tightness, coughing
• Physical: normal b/t episodes; wheezing, prolonged expiratory time, decreased breath sounds
  
  • Use accessory muscles
  • Pulsus paradoxis
• Pulmonary Function test: FEV1/FVC < 70%

Question 23

Clinical Presentation of Pneumothorax

Answer 23

• History: sudden onset plueritic chest pain, not relieved w/ O2 therapy
• Physical: absent breath sounds
  
  • tracheal deviation away from effected side
  • Hyperresonance
  • Deep sulcus sign: supine sharper than normal costophrenic angles
• Additional test: CT